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  #1  
Old 07-19-2012
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Psyche Can you guess which type of Dementia!

A 72-year-old woman complains of difficulty "finding the right word" when she is speaking. Her daughter notes that she also frequently complains that her neighbor is stealing her newspapers when this is not the case in actuality. Recently, the patient has been having difficulty balancing her checkbook as well. On physical examination, her blood pressure is 160/1 00 mmHg and her heart rate is 90/min. The exam is otherwise unremarkable. Over the course of the next three years, the patient develops a severe memory deficit, and suffers from poor sleep, slowness of movement, shuffling gait and urinary incontinence. Which of the following is the most likely diagnosis?

A. Alzheimer's dementia
B. Dementia with Lewy bodies
C. Multiinfarct dementia
D. Vitamin B 12 deficiency
E. Normal pressure hydrocephalus
F. Huntington's disease
G. Chronic subdural hematoma
H. Pseudodementia
I. Hypothyroidism
J. Thiamine deficiency
K. Drug-induced dementia
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Old 07-19-2012
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A. Alzheimer's dementia

confusion can be with
B. Dementia with Lewy bodies -- due to shuffling gait and decreased motion -- but that is a little non specific. there is no tremors, flat affect/hypomimia and other features of parkinsonism etc

E. Normal pressure hydrocephalus - triad of dementia, ataxia and urinary incontinence
all are present.. but the history shows progression of symptoms.. with ataxia and incontinence appearing much later than the dementia.

G. Chronic subdural hematoma
possible.. but again this would lead to a symptom complex similar to NPH.




note --gait disturbances and urinary incontinence can occur in almost all forms of dementia at later stages.
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Old 07-19-2012
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Originally Posted by tyagee View Post
A 72-year-old woman complains of difficulty "finding the right word" when she is speaking. Her daughter notes that she also frequently complains that her neighbor is stealing her newspapers when this is not the case in actuality. Recently, the patient has been having difficulty balancing her checkbook as well. On physical examination, her blood pressure is 160/100 mmHg and her heart rate is 90/min. The exam is otherwise unremarkable. Over the course of the next three years, the patient develops a severe memory deficit, and suffers from poor sleep, slowness of movement, shuffling gait and urinary incontinence. Which of the following is the most likely diagnosis?

A. Alzheimer's dementia
B. Dementia with Lewy bodies
C. Multiinfarct dementia
D. Vitamin B 12 deficiency
E. Normal pressure hydrocephalus
F. Huntington's disease
G. Chronic subdural hematoma
H. Pseudodementia
I. Hypothyroidism
J. Thiamine deficiency
K. Drug-induced dementia
C. Multiinfarct dementia
She has features of everything in a stepwise manner (spread over time) with a high BP.
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Old 07-19-2012
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Ans alzheimers...

For multiinfarct dementia....one should see evidence of stroke(s) or at least a TIA or recurrent TIAs...cause remember its an INFARCT...when brain tissue dies the patient must manifest some physical symptoms first before dementia sets in....
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This patient has Alzheimer's disease, the most common cause of dementia in the United States. It affects up to 50% of people over age 85 and is the sixth leading cause of death among the elderly. Early signs include visuospafial deficits (e.g. getting lost in one's own neighborhood) and problems with anterograde memory formation (old memones tend to be preserved). Personality and behavioral changes (e.g. hypersexuality, agitation) may occur as the, disease progresses. Hallucinations and changes in alertness are late findings.

(Choice B) Unlike Alzheimer's disease, dementia with Lewy bodies presents with alterations in alertness, visual hallucinations, and extrapyramidal symptoms. Memory deficits occur later in the course of disease as compared to Alzheimer's.

(Choice C) Muicinfarct dementia is the second most common cause of dementia in the United States. There is often a stepwise deterioration as damage from multiple strokes slowfy accumulates. Psychiatric disturbances like depression and agitation are common.

(Choice D) Vitamin B12 deficiency is one of the few reversible causes of dementia. The dementia is classically accompanied by megaloblastic anemia and posterior spina! column deficits.

(Choice E) Norma! pressure hydrocephalus (NPH) is characterized by dementia, abnormal gait, and urinary incontinence. The gait is broad-based and shuffling. Patients tend to be bradykinedc. Tremor is rarely present.

(Choice F) Huntington's disease is an autosomal dominant neurodegenerative disease affecting the caudate and putamen. The mean age of onset is between 35 and 44 years. Symptoms include choreoathetoid movements, behavioral disturbances, and dementia. Treatment is supportive.

(Choice G) Chronic subdural hematomas are usually found in elderly and alcoholic patients due to decreased brain volumes and propensity for falls in these patients. They present insidiously with decreased consciousness, headache, cognitive and memory deficits, balance problems, aphasia, and/or motor deficits.

(Choice H) In the elderly, major depression can present as so-called pseudodementia. Depressed patients may have memory changes and other symptoms concerning for dementia. However, once the depression is treated, the dementia-like symptoms resolve. Thus, it is important to evaluate a patient's mood when determining the etiology of their changes in memory.

(Choice I) Hypothyroidism can cause changes in mentation (e.g. poor memory, decreased attention, fatigue). particularly in older patients. Other symptoms include skin and hair changes, weight gain, constipation, and bradycardia This patiefftjpes not have other gvstemic suggestions of Hypothyroidism.
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Old 07-20-2012
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Ans is indeed Alzheimer's


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